Small Solutions for Primary Care Are Part of a Larger Problem
Authors: Derjung Mimi Tarn, Neil S. Wenger, Kurt C. Stange
Journal: Annals of Internal Medicine (2022)

Ideas and OpinionsAugust 2022Small Solutions for Primary Care Are Part of a Larger ProblemDerjung Mimi Tarn, MD, PhD, Neil S. Wenger, MD, MPH, and Kurt C. Stange, MD, PhDDerjung Mimi Tarn, MD, PhDDepartment of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (D.M.T.), Neil S. Wenger, MD, MPHDivision of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (N.S.W.), and Kurt C. Stange, MD, PhDCenter for Community Health Integration and Departments of Family Medicine and Community Health, Population and Quantitative Health Sciences, Oncology, and Sociology, Case Western Reserve University, Cleveland, Ohio (K.C.S.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4509 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Over the past 4 decades, many efforts have sought to improve the delivery of primary care (1). Each practice improvement initiative has promise, and sometimes scientific evidence of efficacy, to improve care for the single disease or process targeted. Yet, implementation of initiatives requires time, training, possible practice redesign, and growing administrative burden (2). Initiatives also may require extensive patient education to manage or reframe expectations. These efforts may yield additional payment, but often the remuneration is not commensurate with the administrative burden required to claim it (2). At a time when patients require whole-person care to improve their overall ...References1. Miller WL. The story of general practice and primary medical care transformation in the United States since 1981. 1 June 2020. Accessed at www.nap.edu/resource/25983/The%20Story%20of%20General%20Practice%20and%20Primary%20Medical%20Transformation%20in%20the%20United%20States%20Since%201981.pdf on 20 May 2021. Google Scholar2. Bujold E. The impending death of the patient-centered medical home. JAMA Intern Med. 2017;177:1559-1560. [PMID: 28973064] doi:10.1001/jamainternmed.2017.4651 CrossrefMedlineGoogle Scholar3. Epstein RM, Fiscella K, Lesser CS, et al. Why the nation needs a policy push on patient-centered health care. Health Aff (Millwood). 2010;29:1489-95. [PMID: 20679652] doi:10.1377/hlthaff.2009.0888 CrossrefMedlineGoogle Scholar4. Heath I, Rubinstein A, Stange KC, et al. Quality in primary health care: a multidimensional approach to complexity. BMJ. 2009;338:b1242. [PMID: 19342404] doi:10.1136/bmj.b1242 CrossrefMedlineGoogle Scholar5. Casalino LP. The unintended consequences of measuring quality on the quality of medical care. N Engl J Med. 1999;341:1147-50. [PMID: 10511617] CrossrefMedlineGoogle Scholar6. Colburn JL, Nothelle S. The Medicare annual wellness visit. Clin Geriatr Med. 2018;34:1-10. [PMID: 29129209] doi:10.1016/j.cger.2017.09.001 CrossrefMedlineGoogle Scholar7. Ganguli I, Souza J, McWilliams JM, et al. Practices caring for the underserved are less likely to adopt Medicare's annual wellness visit. Health Aff (Millwood). 2018;37:283-291. [PMID: 29401035] doi:10.1377/hlthaff.2017.1130 CrossrefMedlineGoogle Scholar8. National Academies of Sciences, Engineering, and Medicine. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. National Academies Pr; 2021. Google Scholar9. Lynch J. A Whole Person Approach to Wellbeing: Building Sense of Safety. Taylor & Francis; 2021. Google Scholar10. Grumbach K, Bodenheimer T, Cohen D, et al. Revitalizing the U.S. primary care infrastructure. N Engl J Med. 2021;385:1156-1158. [PMID: 34432974] doi:10.1056/NEJMp2109700 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (D.M.T.)Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (N.S.W.)Center for Community Health Integration and Departments of Family Medicine and Community Health, Population and Quantitative Health Sciences, Oncology, and Sociology, Case Western Reserve University, Cleveland, Ohio (K.C.S.).Acknowledgment: The authors thank the patients and practices participating in the study Medicare Annual Wellness Visit Practice Redesign Toolkit: A Tailored Intervention to Improve Preventive Health Service Use. They also thank Wilson Pace, MD; Natalia Loskutova, MD, PhD; the DARTNet Institute; and the American Academy of Family Physicians National Research Network for their insights and contributions.Grant Support: The study Medicare Annual Wellness Visit Practice Redesign Toolkit: A Tailored Intervention to Improve Preventive Health Service Use was supported by grant R61AG068946 from the National Institute on Aging. Dr. Stange's time is also supported by a grant from the University Suburban Practice Foundation for the Wisdom of Practice Initiative, and by a Distinguished Scholar Fellowship from the American Board of Family Medicine Foundation.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4509.Corresponding Author: Derjung Mimi Tarn, MD, PhD, David Geffen School of Medicine at UCLA, Department of Family Medicine, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024; e-mail, [email protected]ucla.edu.Author Contributions: Conception and design: K.C. Stange, D.M. Tarn.Analysis and interpretation of the data: K.C. Stange, D.M. Tarn, N.S. Wenger.Drafting of the article: K.C. Stange, D.M. Tarn.Critical revision for important intellectual content: K.C. Stange, D.M. Tarn, N.S. Wenger.Final approval of the article: K.C. Stange, D.M. Tarn, N.S. Wenger.Obtaining of funding: K.C. Stange, D.M. Tarn, N.S. Wenger.Administrative, technical, or logistic support: D.M. Tarn.This article was published at Annals.org on 28 June 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Underuse of Medicare's Prevention and Coordination Codes in Primary Care Sumit D. Agarwal , Sanjay Basu , and Bruce E. Landon Metrics August 2022Volume 175, Issue 8Page: 1179-1180KeywordsHealth careMedical servicesMedicarePatientsPrevention, policy, and public healthPrimary care ePublished: 28 June 2022 Issue Published: August 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...